The Emergence and Utilization of Peer Support in Mental Health Treatment

Peer support, a form of self-help and mutual aid exchanged in diverse settings to address a broad range of physical, mental, and emotional issues, draws on theoretical concepts such as social support, experiential knowledge, and social learning theory. In 2007, the Centers for Medicare and Medicaid Services (CMS) recognized peer support services as both an evidence-based mental health model of care and an important component in a state's delivery of effective mental health and substance use disorder treatment. In 2009, SAMHSA recognized peer supporters as important service providers and designated the International Association of Peer Specialists (iNAPS) among the five mental health professional organizations to train thousands of traditional and peer support staff providing mental health services. Over the past decade, the number of peer support workers has seen exponential growth, from approximately 10,000 in 2005 to more than 25,000 in 2016. As of 2016, 41 states and the District of Columbia are eligible to bill Medicaid for peer support services based on certification in that state. The use of peer support workers in mental health has been researched and demonstrates that peers providing conventional mental health services can be effective in engaging people into care, decreasing the use of emergency rooms and hospitals, and reducing substance use among persons with co-occurring substance use disorders Given these potential benefits, it is prudent to explore some of the complexities involved in hiring and sustaining peer employees, particularly in organizations offering traditional treatment services. Despite the increasing visibility of peer supporters and their recognition as important service providers in mental health treatment settings, many organizations that either employ peers, or indicate interest in expanding their workforce to include peers, continue to face challenges related to: (1). Lack of opportunities that promote social support for peer employees; (2).The dearth of experience supervising individuals who are transitioning their role from patient to worker; (3). Poor compensation and lack of career advancement opportunities for peer staff; and (4). Prevailing attitudes of skepticism regarding readiness and stability of peer support workers to adapt and function effectively on the job. If these implementation challenges remain unaddressed, hiring, integration, job satisfaction, and retention among peer staff will be severely compromised. Identifying and replicating promising practices for hiring, integrating and sustaining peer employees in delivery systems providing traditional mental health and recovery-oriented services can ultimately help improve the care experience for individuals receiving services, increase population health outcomes, and deliver care more efficiently by integrating the lived experience paradigm in treatment. These intents parallel the Institute for Healthcare (IHI) Triple Aim objectives, which are part of the Affordable Care Act. As potential presenters, we would use this workshop as a space in which to share various professional experiences, practice approaches and lessons learned to engage workshop participants in making recommendations for integrating peer staff in mental health treatment settings. We will achieve this goal through small group discussions focused on three important perspectives of peer workforce development and implementation: administrative and policy considerations, clinical supervision, and research methods.